OVERVIEW OF BREAST PATHOLOGY Shahin Sayed, MMed, FCPath(ECSA) Assistant Professor, Department of Pathology, Aga Khan University Hospital, Nairobi

OUTLINE OF PRESENTATION Overview of Normal Breast Anatomy and Cytology Role of Pathology in Breast Cancer Diagnosis

PATHOLOGY – “Pathos” and “Logos” THE STUDY OF DISEASE

HISTOLOGYCYTOLOGY Study of tissues Complex Costly Study of cells Simple Cheaper

NORMAL ANATOMY OF BREAST NORMAL ANATOMY OF BREAST Two major structures ( ducts and lobules) Two types of cells (luminal and myoepithelial) and stroma 6-10 ducts open into areola Branching of the large ducts leads to terminal duct lobular unit (TDLU) Breast cancers arise from the TLDU

WHAT IS THE ROLE OF PATHOLOGY IN BREAST CANCER ? Establish an accurate diagnosis in case of a mass lesion (Benign, Malignant) Confirm a diagnosis of suspected breast cancer For prognosis (grade and stage of tumour, risk of metastases, relapse of cancer) For prediction of response to therapy For choosing appropriate treatment ( hormonal therapy, Herceptin)

ACCURATE DIAGNOSIS OF BREAST DISEASE ACCURATE DIAGNOSIS OF BREAST DISEASE History and Physical exam Screening mammogram Ultrasound for palpable breast masses Ductography (for nipple discharge) Fine Needle Aspiration Cytology (FNAC) for palpable masses and image guided FNAC for non palpable/ small masses Image guided core needle biopsy (CNB)

TECHNIQUES FOR FNAC FREE HAND SYRINGE AND NEEDLE SYRINGE HOLDER IMAGE DIRECTED MULTIPLE DIRECTIONS

FAT CELLS IN ASPIRATE FROM NORMAL BREAST BENIGN DUCTAL CELLS IN FNAC OF NORMAL BREAST MALIGNANT DUCTAL CELLS IN FNAC FROM BREAST MASS

THE TRIPLE TEST IN BREAST DIAGNOSIS The TT is the combination of physical examination(CBE), imaging and cytologic findings of the FNA All breast FNAs need to be evaluated in this context, and management is based upon the combination of this information Using this as the standard: The false-negative rate of TT diagnosis approaches that of surgical biopsy

IF TRIPLE TEST IS NEGATIVE Negative FNA should not rule out biopsy if clinical suspicion of malignancy persists But negative cytology, negative clinical examination and negative radiologic findings together have a negative predictive value close to 100% (Breast J 2004;10:487)

CORE BIOPSY FOR ACCURATE DIAGNOSIS

WHAT IS THE ROLE OF PATHOLOGY IN BREAST CANCER ? Establish an accurate diagnosis in case of a mass lesion (Benign, Malignant) Confirm a diagnosis of suspected breast cancer For prognosis (grade and stage of tumour, risk of metastases, relapse of cancer) For prediction of response to therapy For choosing appropriate treatment ( hormonal therapy, Herceptin)

Grading and ER/PR/HER2 testing of Breast Cancers

WHAT IS THE ROLE OF PATHOLOGY IN BREAST CANCER ? Establish an accurate diagnosis in case of a mass lesion (Benign, Malignant) Confirm a diagnosis of suspected breast cancer For prognosis (grade and stage of tumour, risk of metastases, relapse of cancer) For prediction of response to therapy For choosing appropriate treatment ( hormonal therapy, Herceptin)

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